Untiedt, Stephanie Ann

Untiedt, Stephanie Ann is an sole proprietor health care provider with primary practice located at 4343 Abbott Ave S , Minneapolis MN 55410-1442. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counseling, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Counseling is her primary health care specialty. Untiedt, Stephanie Ann can be contacted via phone (612) 206-1465.

Contact Information

Primary practice address
4343 Abbott Ave S Minneapolis MN 55410-1442
Phone: (612) 206-1465
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counseling 103TC1900X 4599 Minnesota
Behavioral Health & Social Service Providers / Clinical 103TC0700X 4599 Minnesota

Profile Details

NPI number 1093756041
LBN Legal business name Untiedt, Stephanie Ann
Credentials PH.D., L.P.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 9th, 2006
Last updated Feb 1st, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093756041 NPPES
Minnesota MEDICAID 385486800

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